超声造影结合AFP、SAA/CRP水平在肝细胞腺瘤及肝细胞癌鉴别诊断中的应用  

Application of contrast-enhanced ultrasound combined with serum alpha fetoprotein(AFP)and amyloid A/C-reactive protein(SAA/CRP)levels in the differential diagnosis of hepatocellular adenoma and carcinoma

作　　者：王倩 梁爽 李静[1] 徐佳琪 王方旭 WANG Qian;LIANG Shuang;LI Jing;XU Jia-qi;WANG Fang-xu(Department of Ultrasound,Beijing University of Traditional Chinese Medicine Dongfang Hospital Qinhuangdao Hospital(Qinhuangdao Traditional Chinese Medicine Hospital),Hebei 066000,China;Department of Radiology,Beijing University of Traditional Chinese Medicine Dongfang Hospital Qinhuangdao Hospital(Qinhuangdao Traditional Chinese Medicine Hospital),Hebei 066000,China)

机构地区：[1]北京中医药大学东方医院秦皇岛医院(秦皇岛市中医医院)超声科,河北066000 [2]北京中医药大学东方医院秦皇岛医院(秦皇岛市中医医院)放射科,河北066000

出　　处：《肝脏》2025年第2期211-215,共5页Chinese Hepatology

基　　金：河北省自然科学基金(H2021209026)。

摘　　要：目的评估超声造影(contrast-enhanced ultrasound,CEUS)结合血清甲胎蛋白(alpha-fetoprotein,AFP)、血清淀粉样蛋白A/C反应蛋白(serum amyloid A/C-reactive protein,SAA/CRP)水平在肝细胞腺瘤(hepatocellular adenoma,HCA)与肝细胞癌(hepatocellular carcinoma,HCC)鉴别诊断中的价值。方法回顾性分析2020年3月—2023年6月于秦皇岛市中医医院治疗的119例患者,其中60例为HCC患者(高分化28例,低分化32例),29例为HCA患者,其中肝细胞核因子1α(HNF1α)失活型(H-HCA)患者10例,β-catenin活化型(β-HCA)患者10例,炎性HCA(I-HCA)患者9例。所有患者均接受了CEUS检查,比较各组患者CEUS参数(始增时间、始增强度、达峰时间及达峰强度),通过酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)测定患者血清AFP、SAA、CRP水平,并构建受试者操作特征(receiver operating characteristic,ROC)曲线、进行COX多因素分析评估超声造影结合AFP、SAA/CRP水平在HCA及HCC中的诊断价值。结果CEUS参数(始增时间、达峰时间及达峰强度)在HCC患者中均低于HCA患者(P<0.05),SAA/CRP水平能够区分HCA与HCC;特别是在HCC患者中,生物标志物水平能反映疾病分化程度,显示出高敏感度和特异度;超声造影结合AFP、SAA/CRP水平的联合诊断在HCA及HCC的检测中表现出最高的诊断效能,其AUC值为0.953,灵敏度为93.1%,特异度为90.0%,约登指数为0.831,高于单独诊断方法;行多因素COX分析显示,始增时间、始增强度、达峰时间及达峰强度、AFP和SAA/CRP水平均为影响HCA及HCC诊断的因素(P<0.05)。结论CEUS结合血清AFP、SAA/CRP水平的检测为HCA与HCC的鉴别诊断提供了一种高度准确的方法。这种联合检测方法的高敏感度和特异度可能对临床决策和患者的治疗方案选择有重要影响。Objective To evaluate the effectiveness of contrast-enhanced ultrasound(CEUS)combined with serum alpha fetoprotein(AFP)and serum amyloid A/C-reactive protein(SAA/CRP)levels in distinguishing between hepatocellular adenoma(HCA)and hepatocellular carcinoma(HCC).Methods A retrospective analysis was conducted on 119 patients treated in Qinhuangdao Traditional Chinese Medicine Hospital from March 2020 to June 2023.Among them,60 were HCC patients,(28 with high differentiation and 32 with low differentiation),and 29 were HCA patients.Among them,10 were HNF1a mutant(H-HCA)patients,10 wereβ-Catenin mutant with HCA,and 9 were inflammatory HCA type(IHCA).We compared the CEUS parameters(starting time,starting intensity,peak time,and peak intensity)of all patients underwent CEUS examination.Serum AFP,SAA,and CRP levels were measured using enzyme-linked immunosorbent assay(ELISA).The receiver operating characteristic(ROC)curves and COX multivariate analysis were performed to evaluate the combination of CEUS,AFP,and SAA/CRP levels in diagnosing HCA and HCC.Results CEUS parameters(onset time,peak time,and peak intensity)in HCC group were lower than that in HCA group(P<0.05),and SAA/CRP levels could distinguish between HCA and HCC;The level of biomarkers can reflect the differentiation degree of HCC,showing high sensitivity and specificity;The combination of CEUS with AFP and SAA/CRP levels showed the highest diagnostic efficacy in the detection of HCA and HCC,with an area under the curve of 0.953,sensitivity of 93.1%,specificity of 90.0%,and a Yoden index of 0.831,which achieved better diagnostic efficacy than using a single indicator;Multivariate COX analysis showed that the onset time,onset intensity,peak time and intensity,AFP and SAA/CRP levels were all factors affecting the diagnosis of HCA and HCC(P<0.05).Conclusion CEUS combined with the serum AFP and SAA/CRP provides a higher accurate method for the differential diagnosis of HCA and HCC.The high sensitivity and specificity of this combination method may have a significa

关 键 词：超声造影 血清甲胎蛋白 血清淀粉样蛋白A/C反应蛋白 肝细胞腺瘤 肝细胞癌 诊断价值 

分 类 号：R735.7[医药卫生—肿瘤]